NAIROBI, Kenya — The Kenya Union of Post-Primary Education Teachers (KUPPET) has issued a seven-day ultimatum to the Social Health Authority (SHA), demanding urgent reforms to address systemic failures affecting teachers’ access to healthcare under the government-managed medical cover.
Union officials warned that persistent system breakdowns, delayed claims processing, and limited hospital participation are leaving thousands of teachers unable to access medical services.
KUPPET Secretary-General Akelo Misori said the current system has effectively collapsed, forcing teachers to struggle through bureaucratic hurdles that previously did not exist under earlier medical cover arrangements.
“We have been having a medical cover which did not compel us to come to hospitals to establish pay bill numbers for contribution or to raise funds in county halls,” Misori said. “But what is happening now is not supposed to be what teachers should undergo.”
He noted that several hospitals in Nairobi have begun withdrawing services because of delayed claims settlements and an overwhelmed pre-authorisation system.
“In Nairobi alone, hospitals are withdrawing because the system of claims is fatigued. The system of pre-authorisation is also fatigued,” Misori added, warning that continued failures could compromise the well-being of teachers across the country.
Teachers turning to harambees
KUPPET National Chairman Omboko Milemba said the deteriorating situation has forced teachers to revert to community fundraising to cover urgent medical bills — a practice the union says had largely disappeared under the previous scheme.
“This is something we have never seen in the last 16 years,” Milemba said. “SHA is not working for teachers. We are back to raising funds so that a teacher can access hospital services, and we will not accept that.”
He revealed that teachers and the union have already mobilised Sh1.5 million through contributions to support affected members.
Milemba warned that the union would consider withdrawing teachers from the scheme if the authority fails to resolve the issues within the seven-day deadline.
“If SHA cannot manage teachers’ medical cover, then they should step aside. And if they do not, we will withdraw from it,” he said.
Transition to the SHA scheme
Teachers moved to the SHA Mwalimu Cover on December 1, 2025, following the expiration of the contract held by Medical Administrators Kenya Limited (MAKL), which previously managed the health insurance scheme for teachers under the Teachers Service Commission (TSC).
MAKL had directed hospitals to stop providing services to teachers from November 30, 2025, after its agreement with the commission ended.
The SHA Mwalimu Cover was introduced as a comprehensive health package covering inpatient and outpatient care, maternity services, chronic illness management, dental and optical treatment, emergency evacuation, last-expense cover, and overseas treatment.
The scheme extends coverage to the principal member, one declared spouse, and up to five children aged between 0 and 21 years, or up to 25 years if they are full-time students. Children with disabilities registered with the National Council for Persons with Disabilities are also included.
Growing scrutiny of the SHA rollout
The dispute adds to growing scrutiny of the Social Health Authority, which replaced the former National Health Insurance Fund under the government’s broader healthcare reform programme.
While the reforms aim to expand universal health coverage, unions and civil society groups have raised concerns about implementation challenges, system readiness, and funding structures.
KUPPET leaders say the current crisis highlights the need for urgent administrative reforms to ensure teachers — who contribute significantly to the fund — receive reliable healthcare services.
“If the system continues like this,” Misori warned, “the lives of the teachers we represent will be compromised.”
The union says it expects a formal response from SHA within seven days, failing which it will announce further action.
